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ORIGINAL ARTICLE |
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Year : 2021 | Volume
: 34
| Issue : 3 | Page : 914-919 |
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Psoriasis and sexual dysfunction in women
Sara M Abd Elazeem, Mohammed A Gaber
Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Date of Submission | 16-Mar-2020 |
Date of Decision | 16-Apr-2020 |
Date of Acceptance | 15-May-2020 |
Date of Web Publication | 18-Oct-2021 |
Correspondence Address: Sara M Abd Elazeem Nasir City, Cairo Egypt
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/mmj.mmj_95_20
Objective The aim of the present study was to analyze the effect of psoriasis on sexual function in Egyptian women. Background Psoriasis has a significant effect on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25–70% of patients. Patients and methods A case–control study was performed with a convenience sample of 300 participants, consisting of patients with a diagnosis of psoriasis (psoriasis group) treated at the psoriasis unit, Al-Houd Al-Marsoud Hospital, and healthy volunteers (healthy control group). Results The results revealed that the mean score for women with genital lesion was 12.4 ± 5.03, and the mean score for psoriatic women without genital lesion was 15.3 ± 5.8, with a statistically significant difference (P = 0.003). Moreover, we demonstrated that the overall scale of female sexual function index, except satisfaction, was lowered in women with genital lesion than those who do not have. Conclusion Psoriasis is a stigmatizing disease that impairs QoL and harms self-esteem through its effect on social relationships and self-perception, with a negative effect on physical, mental, and sexual health. The high prevalence of sexual dysfunction in our patients highlights the need for a more comprehensive approach to the health of women with psoriasis beyond assessment of their skin condition and the extent of the disease, including other QoL issues and specifically sexual function.
Keywords: female sexual function index, genital, psoriasis, quality of life, satisfaction, sexual, stigmatizing
How to cite this article: Abd Elazeem SM, Gaber MA. Psoriasis and sexual dysfunction in women. Menoufia Med J 2021;34:914-9 |
Introduction | | |
Psoriasis is a systemic chronic inflammatory immune-mediated disorder that results from genetic predisposition combined with environmental triggers, characterized by sharply demarcated erythematous scaly plaques. There are many clinical variants of psoriasis. The most common is psoriasis vulgaris. Psoriasis has a chronic course of remission and exacerbation, with predilection to elbow, knee, presacrum area, and scalp, and there are special locations, for example, flexural, nail, hand and feet, joints, and mucosa [1]. The reported prevalence of psoriasis in Egypt ranges from 0.19 to 3% [2]. In addition, the worldwide prevalence is 1–3% [3].
Because the skin is the interface between the world and the body, the skin elucidates how the physical and the psychological factors interact and affect the health. Therefore, it is important for clinicians to be aware that psoriasis can have a substantial emotional effect on an individual, which is not necessarily related to the extent of the skin disease [4].
The interest in studying the effect of psoriasis on the quality of life (QoL) has been established since 1970 when Jobling [5] found that more than 80% of the psoriatic patients have many social difficulties.
Since then, the interest in the effect of psoriasis on psychological and social life increased, and many studies have focused on the suffering of these patients because of the feeling of shame and of being socially stigmatized owing to the visible lesion and the reaction of fear and disgust from others [6].
Moreover, this affects the relationship of patient with others as they focus on the reaction and the perception of the others to their appearance [7]. Normal sexual function is one of the key point in maintaining normal QoL as defined by the World Health Organization [8].
Sexual dysfunction in woman is known as a lack of adequate function in any phase in the sexual cycle, such as disorders of desire, libido, arousal, pain, and anorgasmia [9]. It is important for the physician to consider the effect of chronic skin diseases and its association with social, emotional, and sexual stress [10]. In this study, we analyzed the effect of psoriasis on sexual function in Egyptian women.
The aim of the present study was to analyze the effect of psoriasis on sexual function in Egyptian women.
Patients and methods | | |
The study was approved by the ethics committee in Menoufia University. Informed consents were taken from the patients before the beginning of the study. This case–control study was conducted on 150 female patients with psoriasis aged 18–45 years and 150 female controls who were matched for age, social, and educational level with the cases, with no clinical complaint at the time of the study. Patients were chosen from psoriasis outpatients in El-Houd El-Marsoud Hospital, and controls were recruited from healthy female volunteers. This study was conducted in the period from March 2019 to October 2019.
Inclusion criteria for all the participants were married women, age 18–45 years, with active sexual life, and clinical diagnosis of psoriasis, as determined clinically by an experienced dermatologist, dermoscopy, and or pathology study. For the control group, an inclusion criterion was the absence of diagnosis of psoriasis.
Exclusion criteria for all participants were widows and divorced women; other dermatological diseases in psoriasis cases; systemic diseases, for example, liver, kidney, or heart diseases; diabetes mellitus; any endocrinal disorders; and any condition that could influence sexual function, for example, pregnancy, infant delivery in past 6 months, polycystic ovary, diabetes, genital diseases or infection, and antipsychotic and antidepressant medications within the past 3 months.
Every participant was subjected to the following: after receiving oral and written information, written informed consent was obtained from each participant before their enrollment in the study; complete history taking; general examination; and local examination of dermatological lesions with assessment of psoriasis severity with psoriasis area and severity index (PASI) score.
The patients filled out a questionnaire which consisted of questions about the effect of psoriasis on social life like feeling of stigmatization because of the lesion and how relationship with her family was affected.
Female sexual function is assessed according to the female sexual functioning index (FSFI), which is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual disorder. In our study, we used the Arabic translated version, which consists of 19 items that assess sexual desire, arousal, lubrication, orgasm satisfaction, and pain during or after sexual intercourse.
For each domain, a calculated score was compared between cases of women with psoriasis and normal women.
Statistical analysis
The sample calculation was based on past review of a literature study by Kurizky et al. [11], who reported that the difference in prevalence of sexual dysfunction between patients with psoriasis and controls was to be 20%. Sample size has been calculated at α = 0.03, 1−β = 90%, and it was calculated as 150 participants per group.
Data were collected, tabulated, and statistically analyzed using an IBM personal computer with Statistical Package of Social Science, version 20 (CDC) in Atlanta, Georgia (US). (2011; IBM Corporations, Armonk, New York, USA), and Epi Info 2000 programs, where the following statistics were applied.
Descriptive statistics: in which quantitative data were presented in the form of mean, SD, and range, and qualitative data were presented in the form numbers and percentages.
Analytical statistics: χ2 test was used to study the association between two qualitative variables.
Mann–Whitney test is a test of significance used for comparison between two groups not normally distributed having quantitative variables, Kruskal–Wallis test (K) is a test used for comparison between more than two groups having quantitative nonparametric variables. P value more than 0.05 was considered not statistically significant, P value less than or equal to 0.05 was considered statistically significant, and P value less than or equal to 0.001 was considered statistically highly significant.
Results | | |
The mean age is 33.4 ± 6.6 years. Among the patients, 46% were working and 54% were housewives, and all were married women. In psoriatic women, 42.9% of the working patients had difficulty in work related to their disease.
As for the clinical status of the patient, most of the patients have psoriasis vulgaris. The severity of the disease is calculated according to PASI score, which ranged from 3 to 36, with a median of 9.3. Overall, 49.3% of the participants had moderate psoriasis, 28% had mild psoriasis, and 22.7% had severe psoriasis. Exposed parts, including hands, feet, and face, were involved in 50.7% and genital involvement was seen in 38.7% of the participants.
There were 22.7% of the participants who felt social stigmata owing to their disease and 11.3% answered may be. Approximately 11% had feelings of guilt and shame owing to their disease, and 11.3% answered may be. Moreover, 16.6% of the participants noticed that there was a change in family attitude and behavior toward them since the appearance of the lesion [Table 1].
There were significant difference between women with exposed lesions and without lesions in exposed areas regarding to feeling of social stigmata, feeling of guilt, and change in family and husband attitude [Table 2].
Regarding the feelings of distress in sexual life, 112 (74.7%) of the participants felt sexual distress, 10 (6.6%) may have sexual distress, and 28 (18.7%) did not feel sexual distress. A total of 109 (73%) participants who felt sexual distress revealed that the distress is related to the appearance of the lesion, and 41 (27%) not related to the appearance of the lesion.
Regarding the areas that distressed the participants more, 50.5% revealed exposed parts distressed them more, 30 (27.5%) reported genital lesions, 11% reported the scalp, and 11% reported the trunk.
According to FSFI, the total score in women having psoriasis was 14.2 ± 5.7 and in controls was 23.3 ± 4.1, with affection of all domains (arousal, desire, orgasm, satisfaction, and pain), and this result is significant, as P value of 0.00 [Table 3] and [Table 4]. | Table 3: The female sexual function index results in analytical representation
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| Table 4: Mean score for female sexual function index overall scale of the studied women
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Sexual dysfunction is also associated with the location of the lesion.
The mean score for females with genital lesion is 12.4 ± 5.03, and the mean score for psoriatic females without genital lesion is 15.3 ± 5.8. So, there is a statistically significant difference, as P value of 0.003. Moreover, the severity of the disease affected the sexual function of the patients [Table 5]. | Table 5: Correlation between female sexual function index and genital psoriasis
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Discussion | | |
The current study confirmed the effect of psoriasis on the QoL. A growing body of real-world evidence has shown that greater psoriasis severity is associated with worse QoL and higher impairments in work productivity [12]. Survey data from the National Psoriasis Foundation in the USA revealed patients with severe psoriasis had a greater likelihood of being unemployed than those having mild disease [13]. In another US survey, Korman et al. [12] found that increased psoriasis severity was associated with more itching, pain, and scaling; poorer QoL; and greater productivity impairment. The study of Weiss et al. [14] reported that many patients with psoriasis experience social and psychological difficulties created by their environment.
Later publications of Ruiz-Villaverde et al. [15], Chen et al. [16], and Ji et al. [17], also addressed the patient, with prevalence of sexual dysfunction ranging from 50 to 65%. Prevalence of sexual dysfunction in our patients was high (58.6%), being statistically higher than in the control group (38.6%). This difference was maintained in the analysis of the association between diagnosis of psoriasis and each of the domains separately (desire, arousal, lubrication, orgasm, satisfaction, and pain), adjusted by age, race, schooling, and marital status, showing that sexual dysfunction is more frequent in the group of patients with psoriasis in all the domains. Gupta and Gupta [18] have found that of 120 patients studied, 49 (40.8%) reported a decline in all sexual activity after the onset of psoriasis.
On the contrary, the current study assessed FSFI score in women with psoriasis regarding affection of genital areas and found that the mean score for women with genital lesion was 12.4 ± 5.03, and the mean score for psoriatic women without genital lesion was 15.3 ± 5.8, with a statistically significant difference (P = 0.003).
The location of lesions also failed to show a significant association with sexual dysfunction, which is consistent with the study by Van Dorssen et al. [19], although differing from the results reported by other authors, who pointed to genital involvement as an important factor in quality of sexual life [20].
Analysis of the psoriatic group revealed that sexual dysfunction is correlated with the severity of the disease and the extent of the lesion. The same relationship was also observed by Guenther et al. [21], who found that patients who achieved a greater improvement, as evaluated by the PASI, experienced a greater reduction in the sexual difficulties caused by psoriasis,. which suggests an association among the reports concerning the social consequences of psoriasis. The first report appeared in the 1970s, by Jobling [5], which found that more than 80% of patients with psoriasis considered troubles in establishing social relationships to be the most difficult aspect of their disease severity of psoriasis and sexual dysfunction. Our study revealed that there were significant differences between women with exposed lesions and without lesions in exposed areas regarding to feeling of social stigmata, feeling of guilt, and change in family and husband attitude. Similar findings were obtained by Ginsburg and Link, [22] who showed that almost all psoriatic individuals experienced stigmatic events in their lives. Another study of Ramsay and O'Raegan [23] reported that 57% of patients with psoriasis felt that people stare at their skin changes and consider them contagious.
On the contrary, Ludwig et al. [24] showed that the location of skin diseases has little influence on the feeling of embarrassment.
Conclusion | | |
Despite its limitations, our study revealed that psoriasis is a stigmatizing disease that impairs QoL and harms self-esteem through its effect on social relationships and self-perception, with a negative effect on physical, mental, and sexual health. The high prevalence of sexual dysfunction in our patients highlights the need for a more comprehensive approach to the health of women with psoriasis, beyond assessment of their skin condition and the extent of the disease, including other QoL issues and specifically sexual function.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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